What is Scapular Winging and Should I Care?

Shoulder stability is key to building a strong foundation of support for your upper body, especially when the upper extremities are moving like when throwing a ball or weight lifting overhead.  A common imbalance we see in the shoulders is scapular winging.

Many people do not know they even have scapular winging because:

  • It usually does not cause discomfort.
  • It is difficult to see your own back, so you don’t even know you have it.

Failure to correct scapular winging can lead to overuse of other muscles, weakness in the primary movers, nerve damage, shoulder impingement and/or other injuries if left uncorrected.

A winged scapula can be visible upon posterior viewing of the back.  Typically we see protrusion of the inferior angle and vertebral (medial border near the spine) of the scapula protruding outward.

Scapular winging indicates:

  • Instability or weakness of the scapular stabilizers (primarily the rhomboids and serratus anterior (S.A.) that fail to hold the scapula in place
  • and/or tightness in the pectoralis minor muscle.

In a normal, healthy back, the scapula should be snug against the posterior ribs with no obvious edges visible as in the photo below.

How to Assess If You Have Scapular Winging

  1. Take a photo of your upper back while standing with arms at your side. Do you see the shoulder blades pop out?
  2. Take a video of you performing a wall push up while shirtless, or wearing a sports bra. Observe for winging of the scapula during movement.  

The photo above left has obvious scapular winging of the right shoulder while the photo on the right shows a fairly flat back with good scapular control during the wall push up test.

Can I Fix It?

To fix the scapular winging involves some Self Myofascial Release  (SMR) techniques, as well as stretching and strengthening exercises that will help to restore balance. First let’s try to figure out the primary culprit(s) for your scapular winging.

Tight Pectoralis Minor Muscle (Pecs)

The pec minor muscle attaches from your ribs to your shoulder blade. Tights pecs (from actual shortening) can occur from front rounding of the shoulders when we sit for prolonged periods or are hunched over a computer. This chronic tightening can tilt your shoulder blade forward, causing the winged look from the back.

Remedies for Tight Pecs

  1. Perform SMR by placing a lacrosse ball or soft ball directly under the pec muscle and rolling out tightness.
  • You can do this while lying on the ground or
  • Standing against a wall or corner of a weightlifting rig and leaning into the ball.
  • Apply pressure into the ball, move your arm around slowly.
  • If you find a painful spot, hold the ball on that area for one minute to release that trigger point.
  • Repeat 2-3 times every day.

2. Doorway Stretch

  • Standing in a doorway, extend both arms against the door trim keeping elbows at a 90 degree. Lean the body through the door slightly to get a good stretch of the Pec Major.
  • Now raise arms a little higher, around 2” with more of a “Y” configuration and do the same stretch. This will stretch the pec minor.
  • This can also be done in a corner of a room.
  • Hold for 1 minute and repeat 2X at each height.

Unengaged Serratus Anterior (S.A.) Muscle

The S.A. muscle holds your shoulder blades against your rib cage. If this muscle is weak, or not engaged appropriately, it will be ineffective, and lead to scapular winging.

Activate (Engage) the Serratus Anterior

  1. Assume a wall plank position with one arm on the wall but place the other arm on your serratus anterior muscles on the opposite side. You should feel the bumps where the S.A. connects to the ribs. Internally pull your shoulder blades down then try to draw your shoulders around the ribs. You will feel the S.A. muscle move when you have properly engaged it. It is difficult for many people to activate this muscle, so take time trying to move the various muscles until you feel it engage.  Once activated:
  • Hold the contraction for 30 seconds.
  • Repeat 5 times.
  • Practice activating the SA during push ups.
  1. Wall Push Exercise – perform a wall push with arms fully extended.
  • Activate the serratus anterior.
  • Push your arms into the wall keeping arms locked.
  • Protract your shoulders (slide then down and around).
  • Do Not round your back.
  • Hold this end position for 5 seconds.
  • Slowly bring your shoulders back to a starting position.
  • Repeat 10 times. Gradually progress to 30 reps.

     

     

    Do NOT round your shoulders

    3. Wall Push in Plank Position:

    • Same as above only have your forearms bent against the wall instead of extended out straight.4. Lying Dumb Bell Protraction:
      • Lie on back with knees bent.
      • Hold a DB straight over your shoulder (easily maintainable weight).
      • Activate the S.A.
      • Push the weight toward the sky while keeping the arm straight.
      • Hold for 5 seconds.
      • Return to starting position.
      • Repeat 10 times. Gradually progress to 30 reps.
Supine DB SA Push

Weak Rhomboids

Strong rhomboids hold the shoulders together, rotate the scapula down and provide stability for the shoulders. They also play a big part in posture. So when the rhomboids are weak, the shoulders tend to round forward, the back hunches over and we can develop pain between our shoulder blades and into our neck.  To strengthen our rhomboids:

  1. Prone Lateral Raises
    • Lie flat on your stomach. Hold a light dumbbell (DB) in each hand or no DB if performing for the first time
    • Place forehead on the floor or mat and keep toes down.
    • Raise the light DB’s with arms fully extended, thumbs up.
    • Once you have reached shoulder height, squeeze your shoulder blades together and hold for 1 sec. The goal is to isolate you back. You will only lift the DB’s a few inches.
    • Inhale, then slowly lower the DB to the starting position.
    • Repeat 8 X, gradually working toward 15 reps.

2. Front Raise Thumbs Up

  • Same as above but arms are straight out in front of you next to your ears.
  • Thumbs should be facing up, with no weights initially.
  • Keeping torso glued to the floor or bench you are lying on, slowly raise arms. Squeeze the muscles between your shoulder blades as you lift as high as you can without breaking form.
  • Hold for 1 second.
  • Repeat 10 times, gradually working to 15 reps.

3. Banded Pull Aparts

  • Using resistance tubing, keep arms at a 90 degree angle, elbows bent at chest level.
  • Extend the arms out laterally, fully extending the tubing until the arms are at full extension.
  • Squeeze the shoulder blades together.
  • Hold for 1 second.
  • Release the tubing slowly and start again.
  • Repeat 10 times, gradually working up to 20 reps.

We have covered a lot of important material regarding shoulder stability.  Now is a good time to perform these exercises if you have any sign of scapular winging or other shoulder weakness.  The strength you develop performing these exercises can prevent a more severe injury down the road.  Remember mobility, stability, strength and intensity, this is the roadmap to moving better and feeling better.

Engage Your Core!

We hear “engage your core” all the time by our Coaches, but what exactly does that mean? Do we suck in the belly just before a movement? Do we keep it sucked in the entire time? How do we breathe when we are sucking in our abs?  This article will answer those burning questions, plus teach you the importance of bracing your core to help us move more effectively.

First, What is Your “Core?”

Your “core” are the muscles that control the position and motion of the trunk over the pelvis, and stabilize the spine for voluntary and involuntary loading.  A strong core allows optimal production, transfer and control of force and motion to other areas of the body, and is the basis for good posture. Those with a weak core are much more prone to suffer back injuries, have greater difficulty with basic and advanced exercises, and are less likely to reach their strength potential.

 

The “Core Box”

Think of your “core” as essentially a box, with each side being several layers thick. It can be divided into front, back, top, and the sides.

 

 

On the posterior surface, or the back, the spinal stabilizing muscles (erector spinae, multifidus and latissimus dorsi) run from your shoulder blades, along your spine and back.  They are important for segmental stabilization of vertebrae, and are rich in sensory nerves, transmitting continual feedback to the brain regarding loading and position of the spine.  These muscles generate gross movement and forces.

The diaphragm muscle forms the top of the “core box”, and is also the primary muscle for breathing. So this is where the breathing part comes in when we teach how to engage our core.  There are many recent studies of how important proper breathing is to sports and movement. There will be more articles on this topic in the future.

The outermost layer on the anterior surface or front is the powerful rectus abdominis muscle, which begins at the pubic bone and ends at the sternum. This muscle is activated while doing crunches because it pulls the ribs and the pelvis in and curves the back. This muscle is also used during childbirth, bowel movements, and coughing. Breathing in and holding the rectus abdominis in pulls in the abdomen. When this muscle is exercised and layers of fat disappear from the abdomen, the exposed rectus abdominis muscle creates the look of a “six pack.”

 

The transverse abdominis (TVA)  is also on the front wall with the rectus abdominis but is the deepest layer.  The TVA is often referred to as the corset muscle since activation produces a hoop effect similar to cinching a belt around the waist.  This contraction pulls in the muscles, stabilizes the low back and pelvis before movement, and increases intraabdominal pressure to help brace the core. Having a strong TVA produces a slimming effect by drawing in the abdominal area.  A weak TVA can cause the lower abdomen to pooch out, and allow the pelvis to become anteriorly rotated, an imbalance that can lead to further dysfunctions.

The quadratus lumborum, external and internal obliques connect the front to the back (ie are the sides of the box), while the pelvic floor musculature comprises the bottom of the “box”.  These muscles stiffen to support loading and movement, and provide a stable foundation for the body to work from.

So How Do I Engage My Core?

First lets see if you can engage your TVA.  You can’t strengthen a muscle you don’t know how to activate.

  1. Lie on your back with knees bent. Find your Anterior Superior Iliac Spine (the ASIS is the top corner of the hip bone).  
  2. Place a finger on your ASIS bone and then slide the finger an inch toward the belly button.
  3. “Draw in” the muscle of the TVA (10- 50%) but not maximal effort because that will engage the rectus abdominis. Another example would be to suck your belly button to your spine. It is important to keep breathing as you maintain a nice easy contraction of the TVA.
  4. You should feel the TVA muscle when you contract it.  You should not have any other movement occurring.

 

Strengthen the TVA

  1. Perform 3 sets X 10 repetitions with a 3 to 5 second tempo and a 10 second rest between each set, while still breathing normally throughout the exercise.
  2. Now do the lying TVA activation but lift one leg while bracing the TVA. Don’t hold your breath or bulge your lower abdomen.
  3. Once you can lift the legs with proper form, lie on your side, and do a clam shell move (keep ankles together and lift your top knee) while maintaining the TVA activation.
  4. Now work toward bracing the core while walking and moving.  

Other Ways to Engage the Core

The various cues for core engagement may vary depending on the specific movement you are doing, but in general, here are a few ways to turn on additional core muscles:

  1. Scapular Retraction.  Press your shoulder blades down and away from your ears as this helps to ‘cap’ the contraction of the abs and engages the core muscles in your back.
  2. Pelvic Floor Contraction.  Think of ‘lifting up’ through the pelvic floor to engage the muscles in the pelvic floor and deepen the contraction of your abdominal muscles.
  3. Proper Breathing.  Use your diaphragm, not only your chest during each breath. Your stomach should also rise and fall with each breath.
    • Breath out during the concentric phase (like the upward pushing during a push up)
    • Breath in during the eccentric phase (at the top of the pushup and during the initial lowering.

Starting Core Exercises To Develop Strength

There are many core exercise that will help strengthen the entire region and provide life lasting benefits for you.  Work your core three times a week on nonconsecutive days for 5 minutes.  Start with the first exercises listed below and progress to more difficult ones and you become stronger.

  1. Dead Bug – Start with keeping knees at 90 degrees and arms elevated. Slowly move one arm back overhead, then the other.  Progress to opposite leg and arms moving while building the number of repetitions.
  2. Quadruped – On hands and knees, slowly extend one leg while maintaining core bracing.  Once comfortable, add in the opposite arm. Extend the length of time you can hold each limb. Also add in movement by tucking the raised knee into the the raised elbow, then extending back again.3. Plank –  Variations include starting on knees, then progressing to elbows, to straight arms, leg or arm lifts then to moving planks and unstable surfaces such as on a Bosu Ball, or large ball.

4. Side Plank – Variations include starting on a knee, then elbow, then straight arm, then moving arms overhead, and then unstable surfaces.

5. There are many more advanced moves like bicycle crunches, atomic sit ups, V-Ups, Oblique twists, etc.  See this Pinterest board for additional core exercises.  https://www.pinterest.com/finney2734/core/

A strong core will make your movement patterns more efficient, decrease chances of a back injury, and will enable you to generate more power to your limbs.  Your posture will improve and if you have ever experienced bouts of incontinence during jump roping, that too can go away with proper core work.  As far as those six pack muscles shining through, these exercises will start you in that direction but six packs are also made in the kitchen.

 

 

 

 

Strict Pull Up Progressions – You Can Do This!

Mastering the strict pull up is a fitness goal many people would like to accomplish. Being a strength based skill, strict pull ups can be difficult to achieve, especially for women who notoriously lack the upper body strength for this movement. The following are key steps for achieving this goal:

  1. Follow a progression program
  2. Be consistent with practice and increasing the level of difficulty
  3. Use good muscle movement patterns
  4. And don’t give up, good things take time to achieve

Commit 15-20 minutes, 3 days a week to the progressions. You need to put in the effort if you want results … you can do this!!!

Level One – Your First Strict Pull Up

Always Warm Up your shoulders before doing any pull up progressions.  Examples include:

  • Arm swings – forward and reverse.  2 X 12
  • Banded face pulls – make sure to retract and depress your scapula together on every pull.  2×12
  • Shoulder rolls forward and back.  2 X 12
  • Arm punches out from chest.  2 X 12
  • Push ups.  2 X 12

Afterwards cool down and stretch out.

  • Foam roll each latissimus dorsi for 1-2 minutes.
  • Foam roll the mid back and do thoracic extensions (arms reaching overhead with thumbs toward the ground).
  • Kneel on both knees with arms extended out in front of you with forearms on a foam roller, push chest down through your arms, toward the ground.

Important Details: A proper pull up should be initiated with the scapula.

Bar Hangs with scapular retraction – This step is crucial to ensuring you know how to activate your scapula. Use a box/bench to climb and grab onto the pull up bar (use a band to assist if necessary). Hold the bar with hands pronated, i.e. palms facing the bar.

Test your ability to do scapular retractions, pulling the scapula together and down. Your body should raise by an inch or two as your back engages. You should be able to do 5 reps of slow, gradual scapular retractions, holding for 2 seconds, then slowly releasing before beginning the push up progression program.

Active Scapular Retraction 
No scapular retraction, forward rounding of shoulders.
  • Do not hang from the bar with a limp form, this will stress the shoulders and potentially cause injury. Pulling up with the arms causes the shoulders to pull forward and down as seen in the photo above.
  • A supinated grip ( palms facing the bar as done in chin ups) is a good variation to use during your progression training.
  • Do not arch the body, swing, or bend at the waist to try and get momentum. A strict pull up is slow and controlled.
  • Every pull up must be started with scapular retractions in place prior to pulling up.

Now you are ready to begin your progressions. It might take several weeks to build the strength, so be patient and trust the process.  Building the requisite muscles takes time.  Before hanging from the bar, practice this pull up variation found below:

 

 

Progressive Workouts:

Vary workouts each week by adding reps and/or weight, and decreasing band size. Constantly varied stimulus with progressive overload are the keys to building strength.

A1) Seated Strict DB Press 3 X 8 at a weight that challenges you by the 8th rep.

Seated DB Press

A2) Scapular retraction bar hangs 3 X 5 (hold 2 seconds each). Start with a band if necessary to help support your weight.

A3) Banded pull ups 3 X 8 with a heavy band down by feet so you are standing on the band.

Low Band Pull Up

 

B1) Accumulate 25 ring rows. Once you can do 10 in a row, lower your angle to make it harder. Eventually work toward having your body parallel to ground with your feet on a box or bench.

B2) Chin over bar holds.  Do a jumping pull up to the bar. Static hold your chin over the bar for 1 – 2 seconds, then slow lower down to the bottom position in a controlled descent over 3 to 4 seconds. This is an eccentric stimulus and is important in building strength.

Pull Up with hollow hold, feet pointed

B3) Banded Pull Ups 3 X 8  with a band looped on the top bar. Reduce the band thickness when able to do so.

Top Banded Pull Up Assist

 

C1) Sitting Strict DB Arnold Press  3 x 8.  Start the press at your chest level, rotate your hands from internal (palms facing in) to external rotation (palms facing forward) during the press. Pause at the top for 1 to 2 seconds.

DB Arnold Press Top

C2) Scapular Retractions bar hangs.  4 X 15 sec holds.

C3) Jumping pull ups. 3 x 8. Make sure to keep core in a hollow hold, with feet tight together and toes pointed forward. Always retract the scapula as you begin to pull.

An example of the programming with varying stimulus is below.  Remember, your programming will begin at a level that you can currently achieve, and then you will increase the difficulty as you progress :

Week 1

Monday: warm up, then do:

A1) Seated 10 lb DB press. 3 X 8;

A2) Scapular retraction bar hangs with a band. 2 X 5 for 2 seconds;

A3) Banded pull ups with thick band at feet for assist. 3 X 8.

Wednesday: warm up, then do:

B1) AMRAP (As many rounds as possible) of Ring Rows until fatigue.

B2) Chin over bar holds. Jump up, hold 2 seconds then slow lower. Do 5X

B3) Band from top bar pull ups with one or two legs in loop. Do AMRAP, rest and do 4 more.

Friday: warm up, then do:

C1) Seated DB Arnold press 10 lb DB press. 3 X 8

C2) Scapular Retractions bar hangs.  4 X 15 sec holds.

C3) Jumping pull ups. 3 x 8.

 

Enjoy the process and the final results will come.